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. 2023 Aug;24(3):265-276.
doi: 10.1177/17511437221116472. Epub 2022 Aug 16.

Reduction in transfer of micro-organisms between patients and staff using short-sleeved gowns and hand/arm hygiene in intensive care during the COVID-19 pandemic: A simulation-based randomised trial

Laura Vincent  1 , Mudathir Ibrahim  2   3 , Joanne Kitchin  2 , Claire Pickering  1 , Jennie Wilson  4   5 , Enrico Sorrentino  1 , Claudia Salvagno  1 , Laurie Earl  2 , Louise Ma  5 , Kathryn Simpson  5 , Rose Baker  6 , Peter McCulloch  1   2
Affiliations

Reduction in transfer of micro-organisms between patients and staff using short-sleeved gowns and hand/arm hygiene in intensive care during the COVID-19 pandemic: A simulation-based randomised trial

Laura Vincent et al. J Intensive Care Soc. 2023 Aug.

Abstract

Background: Current personal protective equipment (PPE) practices in UK intensive care units involve "sessional" use of long-sleeved gowns, risking nosocomial infection transmitted via gown sleeves. Data from the first wave of the COVID19 pandemic demonstrated that these changes in infection prevention and control protocols were associated with an increase in healthcare associated bloodstream infections. We therefore explored the use of a protocol using short-sleeved gowns with hand and arm hygiene to reduce this risk.

Methods: ICU staff were trained in wearing short-sleeved gowns and using a specific hand and arm washing technique between patients (experimental protocol). They then underwent simulation training, performing COVID-19 intubation and proning tasks using either experimental protocol or the standard (long-sleeved) control protocol. Fluorescent powder was used to simulate microbial contamination, detected using photographs under ultraviolet light. Teams were randomised to use control or experimental PPE first. During the simulation, staff were questioned on their feelings about personal safety, comfort and patient safety.

Results: Sixty-eight staff and 17 proning volunteers were studied. Experimental PPE completely prevented staff contamination during COVID-19 intubation, whereas this occurred in 30/67 staff wearing control PPE (p = .003, McNemar). Proning volunteers were contaminated by staff in 15/17 control sessions and in 1/17 with experimental PPE (p = .023 McNemar). Staff comfort was superior with experimental PPE (p< .001, Wilcoxon). Their personal safety perception was initially higher with control PPE, but changed towards neutrality during sessions (p < .001 start, 0.068 end). Their impressions of patient safety were initially similar (p = .87), but finished strongly in favour of experimental PPE (p < .001).

Conclusions: Short-sleeved gowns with hand and forearm cleansing appear superior to sessional long-sleeved gowns in preventing cross-contamination between staff and patients.

Keywords: COVID19; infection control; intensive care; personal protective equipment; simulation.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Prototype Level 2 personal protective equipment doffing and mini-doffing guidance posters used during the simulation.
Figure 2.
Figure 2.
Simulation flow chart.
Figure 3.
Figure 3.
Results of the presence of contamination as shown by UV photography. The error bars show the 95% confidence interval for the percentage contamination, calculated by Wilson’s method.
Figure 4.
Figure 4.
Example photos of participants using Control personal protective equipment: (a) - contamination of participant post intubation, (b) - participant post proning, (c) and (d) – ‘patient’ post proning.
Figure 5.
Figure 5.
Results of the Physical Comfort, Personal Protection and Patient Protection Impression Questionnaire.
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